近年來有關醫療法律糾紛案件有逐漸增加之趨勢，本文嘗試藉由實證分析，剖析目前實務與學理上之不同見解，簡要提出個人淺見。於實證分析前，本論文先就文獻理論作簡略之論述，首要說明醫療行為與醫療糾紛之相關概念，以界定醫師或醫療機構對其醫療行為應負之責任。並從實體法上論述醫療過失民事責任之基礎及其內涵，如醫療契約責任、醫療侵權責任、消保法與醫療法之適用，以及醫療過失之因果關係等。次就程序法上探討民事醫療訴訟舉證責任分配之基本原則，同時就美國法與德國法有關醫療過失舉證責任分配的調整於我國實務上之運用，作概略分析及探討。再者，鑑於法官於具體個案中判斷醫療糾紛之相關要件，往往需將訴訟資料送請醫療專業機構加以鑑定，因此，本文亦加以說明我國醫療鑑定制度運作之現況，並據此指出現行醫療糾紛鑑定問題之所在。 最後，本文就最高法院民事案件，分別從醫療糾紛判決背景資料之「年度」、「醫療機構層級」、「科別」、「上訴人」與「上訴結果」，以及醫療糾紛審判實務，如「醫療過失」、「因果關係的認定」、「民事責任請求權基礎及舉證責任之分配情況」、「告知義務」、「醫療鑑定在醫療糾紛應用」，進行實證分析，並依實證數據成果，提出「醫療科別屬性與醫療糾紛案件量多寡密切攸關」、「法院對於醫師在個案是否盡注意義務，應以理性醫師之注意標準綜合評價」、「針對醫療訴訟特性，適度分配醫病雙方之舉證責任」、「宜建立醫療傷害補償基金制度」、「醫事人員確切履行告知說明義務」、「健全現行病歷表之相關問題」、「關於醫療糾紛鑑定實務」暨「透過消保法填補醫療（院）組織疏失之責任」等八項結論及建議，以供實務與學術研究者未來對於醫療糾紛訴訟案件研析時之參考。 / Recently, legal cases concerning medical dispute have a tendency to increase gradually. This article tries to explore different viewpoints between practice and academic theory by empirical analysis and then briefly indicates some of my humble views. Before doing the empirical analysis, this article will briefly introduce the related literatures and theories. Firstly, explains related concepts between medical behavior and medical dispute to define the liability that doctor and medical institution should bear because of their medical behaviors. Then, discuss the basis and connotation of the civil liability for medical malpractice from the substantive law viewpoint, such as the liability for medical contract, medical tort liability, the implementation of the Consumer Protection Law and the Medical Care Act and the causality from the medical malpractice etc. Secondly, this article will discuss the basic principles of allocation of burden of proof for civil medical dispute from the procedural law viewpoint and in the same time, briefly analyze and research that whether it is appropriate to adopt the allocation of burden of proof for medical malpractice from American and German law in our own practice. Furthermore, respecting the fact that for judges to make their decisions in particular medical dispute cases, they always have to send action materials to professional medical institutes for identification, thus, this article also wants to explain the current situation of implementation of our medical identification system, and points out the problems of current medical dispute identification system accordingly. Lastly, this article will proceed empirical analysis according to the Year, Levels of the medical institutions, Divisions, Appellant, Result of Appeal from the background of the verdicts of the civil medical dispute cases awarded by the Supreme Court and according to the medical malpractice, the determination of the causality, the condition of basis of civil title of claiming and allocation of burden of proof, obligation of informing, medical identification in the medical dispute from the medical dispute trial practice. Base upon these results, this article indicates eight conclusions and suggestions for reference for the active participants and academic researchers in future medical dispute lawsuits: the attribution of the medical care division and the number of the medical dispute cases are closely related, court should do omnibus assessment using the standard of due diligence as a rational doctor to determine whether a doctor fulfill his duty of care in a specific case, with the particularity of medical actions in mind, appropriately allocate the burden of proof between doctor and patient, it is better to establish the compensation foundation system for medical damage, medical personnel should literally perform their obligation of informing, to refine the problems of current medical record, things concerning medical dispute identification practice and using the Consumer Protection Act to fill the vacancy that caused by the negligence of the medical institutions.

Τρεις ευρέως χρησιμοποιούμενες μέθοδοι τυποποίησης, μια βιοχημική (API20NE), μια φαινοτυπική (SDS-PAGE) και μια μοριακή (RAPD) χρησιμοποιήθηκαν για την ταυτοποίηση και ταξινόμηση 160 περιβαλλοντικών ψευδομονάδων που απομονώθηκαν από το υδάτινο περιβάλλον της Νοτιοδυτικής Ελλάδας και συγκεκριμένα από εμφιαλωμένα νερά (46%), νερά δικτύου ύδρευσης (16%), κολυμβητικών δεξαμενών (9%) και θαλασσών (29%). Οι ψευδομονάδες ταυτοποιήθηκαν με βάση το βιοχημικό τους αποτύπωμα δια μέσου του συστήματος ΑΡΙ20ΝΕ, και στη συνέχεια υποβλήθηκαν σε ηλεκτροφόρηση των ολικών πρωτεϊνών τους (SDS-PAGE) και σε ανάλυση του γενετικού τους υλικού με τη μέθοδο RAPD (Random Amplified Polymorphic DNAs) με χρήση δύο διαφορετικών δεκαμερών εκκινητών (primers). Το σύστημα API20NE ταυτοποίησε το 88% των στελεχών διακρίνοντας 14 ομάδες-είδη, ενώ η SDS-PAGE ταξινόμησε το 98.1% σε 20 ομάδες και η RAPD το 94% των στελεχών σε 22 και 34 ομάδες, με εκκινητή τον OPA-13 και τον OPD-13 αντίστοιχα. Η ταξινόμηση προέκυψε με εφαρμογή της ανάλυσης κατά συστάδες (cluster analysis) των αποτυπωμάτων (πρωτεϊνικών και γενετικών) που παρήγαγαν τα στελέχη. Τα 20 στελέχη που δεν ταυτοποιήθηκαν σε επίπεδο είδους με το API20NE, ταξινομήθηκαν με την SDS-PAGE σε ποσοστό 100%, ενώ με την RAPD σε ποσοστό 90%. Οι τρεις μέθοδοι συγκρίθηκαν ως προς την επαναληψιμότητα (reproducibility), την ικανότητα τυποποίησης (typeability) και τη διακριτική ικανότητα (discriminatory power). Την μεγαλύτερη επαναληψιμότητα έδωσαν το API20NE και η RAPD με τον εκκινητή OPA-13, την μεγαλύτερη ικανότητα τυποποίησης η SDS-PAGE, ενώ τη μεγαλύτερη διακριτική ικανότητα έδωσε η RAPD με τον εκκινητή OPD-13. Η πλέον σωστή ταξινόμηση, όπως προέκυψε από τη διακριτή ανάλυση, επιτεύχθη με τη μέθοδο SDS-PAGE. Η παρούσα εργασία αποδεικνύει ότι τα βιοχημικά συστήματα ταυτοποίησης (όπως το API20NE) μπορούν να χρησιμοποιηθούν με αξιοπιστία μόνο για αδρή αναγνώριση των περιβαλλοντικών ψευδομονάδων. Πληροφορίες σε βάθος για την ταυτότητα και τη φύση τους μπορούν να εξαχθούν με τη περαιτέρω εφαρμογή ηλεκτροφορητικών και μοριακών μεθόδων. Δεδομένης της ευρείας διασποράς, της ετερογένειας και της, έστω και δυνητικής, παθογόνου δράσης των ψευδομονάδων, είναι σημαντικό, από πλευράς δημόσιας υγείας, ο προσδιορισμός της ταυτότητάς τους να γίνεται με συνδυασμένη εφαρμογή βιοχημικών, ηλεκτροφορητικών και μοριακών μεθόδων ώστε να καθίσταται δυνατή η αναγνώριση στελεχών που μπορούν να αποτελέσουν αιτιολογικούς παράγοντες ασθενειών, ιδιαίτερα σε ομάδες υψηλού κινδύνου. / Three broadly used typing techniques, one biochemical (API20NE), one phenotypic (SDS-PAGE) and one molecular (RAPD), were employed for the identification and taxonomy of 160 environmental pseudomonas isolated from the aquatic environment in Southwestern Greece. In particular, the isolates were obtained from bottled waters (46%), potable waters (16%), waters from swimming pools (9%) and seawaters (29%). The isolates were identified by the system API20NE and then subjected to whole-cell protein electrophoresis (SDS-PAGE) and Random Amplified Polymorphic DNAs (RAPD) using two 10-mer primers. The API20NE system identified 88% of the whole bacterial population and classified them in 14 species, while SDS-PAGE classified 98.1% of the isolates in 20 groups and RAPD classified 94% of the strains in 22 groups using the primer OPA-13 and 34 groups using the primer OPD-13. The classification was achieved by applying cluster analysis in the protein or RAPD fingerprints of the isolates. Twenty isolates that could not be identified by the API20NE system, at least to the species level, were classified by the SDS-PAGE and the RAPD in a percentage of 100% and 90%, respectively. The reproducibility, typeability and discriminatory power of the three methods were compared to evaluate their application. The API20NE and the RAPD assay with primer OPA-13 showed better reproducibility in comparison with the other methods; the higher typeability was achieved by the SDS-PAGE assay while the higher discriminatory power was that obtained by the RAPD method with the primer OPD-13. The SDS-PAGE gave the higher percentage of “correctly classified” isolates, as it was assessed by discriminant analysis. This study shows that the rapid identification systems, such as the API20NE, may be reliable only for a rough characterization of environmental Pseudomonas. In order to acquire further information about their identities, other phenotypic and molecular techniques have to be applied. Given the ubiquity, heterogeneity and pathogenicity, either established or potential, of the environmental pseudomonas it is important, from a public health point of view, to monitor the identities of environmental Pseudomonas isolates using the combination of specific methods, so as to be possible for strains, which can serve as causative agents of diseases, especially in high risk population, to be recognizable.

The design of any information management system (IMS) requires a clear strategy for its integration into the environment for which it is intended. Information management has been addressed in the objectives and plans of the Government of Uganda since independence in 1962, with varying degrees of success. The extensive changes that have taken place in the last few decades in Ugandan higher education have led to increased demands for managing student information. In turn a strategy for proper coordination of such data is necessary. The major aim of this study was to design such a strategy. The research therefore attempted to investigate the current state of the management and coordination of student information in Uganda. The needs and requirements of a student information management system (SIMS) and strategies for its integration in higher education programmes were established. The study carried out in the education sector was conducted using a qualitative research framework that provided a coherent set of propositions which explains the phenomenon of a SIMS. The researcher purposively selected the respondents (including key informants, administrators and student leaders) in this sector, who included people involved in the capture, storage, management and use of student information in various institutions in the given sector. Observably, the current state of the SIMS lacks a strategy to keep track of student information in Uganda. It was established that to ensure tracking of such data in the country, an identification system with standardised procedures in a coordinating structure is required together with a clear strategy for utilising the existing structures in the education sector. To design a strategy of this kind, a proposed framework for an integrated SIMS defined the principles, environment and contextual boundaries in terms of which the design is created. It defines the structure of a national student identification system and its coordination in the education sector in Uganda. Strategies for ensuring the sustainability of such a system and its implications for the socio-economic environment of higher education are considered. / Information Science / D. Lit. et Phil. (Information Science)